GW1-2021-01317_Well Construction - GW1_20210329

WELL CONSTRUCTION RECORD nlcnndl ,)v1v
I I]I.Lo III..m he u.ed ibI IIIIJc o,Ioulaplc., Il,.
I.IN ell Con l factor In format.,).:
Kevin White 14.WATER ZONES
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It,a11,-onlf'aLlnr Aamc O, ft.
2973
�t tvdlt\,),)moon f'umf—oun1411n1", 15.OUTER CASING for mdti-cued wdh OR LINER ifa 'able
FROM TO UI\Ml1TFR TI11('RC' "ITFRIV.
Parratt-Wolff, Inc. rt. ft. 1.
m. \el,m 16.INNER CASING OR TUBIDING fhermd Blued-too
FROM TO \NIFTFx I'111rACESti MCfFRI\I.
2.NN ell Construction Permit a: 0 ft. 69 ft. 2 seh40 pvc
,,.✓l.,ppLr„hie n,ll p,roan ,_ nnm G.,o IVnm,n.:.!n...ro,n . ,,
3.N\ell I se Icheek"ell loco 17.SCREEN
N\.(Cr Supply NN ell: F fl%l Ttl DIIMFT[R 51aF1SIlE IIIt(ANFSs \I\TFRI%l.
-NntlColt.ral Cilunlnpel Puhh: 69 f'' 2 1p' .01() sch40 pvc
-tieolhctm,d Illeatms( oho�supply -Re,idennal AAatci Suppls I;ul cicl n. ft. In
-lnduan,d( ommcrc1.11 Rcndenual\kiw, iupph IshlicJ) Ia.GROUT
FRONI 1D Nf\Tf RI U. f:MPI.\('LNENT\IETIf O11S\MOI CI
-IIrleanlIII 0 n. B0 n. Portland Cern Trernie
Non-M ate,Snpph Nt ell:
....... _:Rec...cn
Bentonite Chi Trernie
Injection Nell f (4
-,Agullet Recharge Clflrnundlcater Remedlauon 19.SAND/GRAVEL PACKK
FROM TOM\TFRI{I. FNIrI_{C EN1FNTNIFT110D
-:lymfcr Storage andRm,cen -Sal lnm Narncl
64 ft- 71 ft. #1 Sand Trernie
-:Agutter l-esl =}loan vvamr Dral naee
ft. ft.
-FNpenmenud Technulugv ❑Suhsldence C ontrol
20.DRILLING LOG attach dditloaY eheeh if meua
-Geothermal((Insed I.nq,l ❑Imcer FROM lfl DCSCRIYf IOC c.1o,.hardness,sal me k o on,el,)
-Geothermal f l Icaun2 C ooh IT RetuTo) -OtherI plan under l_I Remarks) n. ft.
12/17/20 AS-13 ft. ft.
Uate W-rRlsl Complrted: NVell IDkft. -
Sa.\Cell Location:
ft. O.
Colonial Pipeline Company n n
rI I I I.I.o,.ner�:,I,I I facdll. l0-(It pphcnhlcl h. ft.
14511 Huntersville-Concord Road, Huntersvlle, NC 28078 n
Phl""t Wdlcs.cIl).and n),
]I.REMARKS
Mecklenburg No cover
t'..unn PmT-i ldonlficaum,Au IPIy I
Ch.Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22 Certification: \
of ncll Ildd.one I:o loon Is zu fI I ne nli , ll
35.412977 N --80.805078 NN -4 C� /J I G L
SIs me,dCnufieJ A4 ell t-nnoaan, Uale
6. Is(are)the well(s): fr_I'ermanent or LI I'emporan'
I I rho ham. I hdr.h, nI Al,IIm,,1 moll,)) I,It nrcnb„ ,u.mJ u,un..111 a
� u ulr L,.I At 11 II_'f- Ill uu car I�I At J, ,q, uYPI 14:11 r)unn'm n�,n Rmnderth euJ Ihm e
Is this A repair to an Busting well: ❑N es or 'No .."I ,,nn.r—adbm Aeul.....rolled e„ne I'L0 timer
/r,hnn IT rtl"" /,/Iq',Aueon nell., n,nnmlrnnlornrt,mm.nl.l upl.un d,.nn¢u, mrhr
so...I„.de. 'I..,v...A, dr.IsILA ,In.der,,, 23.Site diagram or additional well details:
You ma, use the hack of this page to pT1lde addnlomd "dl one JCfad5 of Nell
S.Numhe, of wells constructed: 1 cnnsuucuott details You nta\also attach additional pages It ncccssen
h.,r,)adopt.upennn,11r war-I,.ner v,p/.II 1.ell,f Al ah,b, on,eleooi,i.. rvunm
SFRVIITT,IF INSTL(TIONS
9. I oral well depth below land surface 71 Ift.) 24a. For .AII Wells: Srlhmlt itob tot" "Ithm 10 dins of mmpleuon of well
Iornwb,,h -11,l.vell.hp,lo Gdfil—,rI.e.....1 n200 eN 11,III cunstuctom to[lie tollim nliz
11).Static water let III below top of using: Ift.l Division of TIN ater Resources,Information Processing 1 nnL
n 1,,,,1 Ie ad,,I'?""I..,,,,I¢ ,,,, 1611 Mail Sen'ice Center,Raleigh,N('27699-161'
11.Borehole diameter: 2 Pit.) 24b. For Infection \N-ells ONL) In addition to salJme the l om w the address In
8 1/4 HSA '-4auhove_ also suhnut a alpv of I[,,, form r ithm !IT Jay, of canlplcuon of well
12.W'ell construction method: CJn51NCf IOn Iofhe tidloum_I
u. Ir IT_ II I.I,Icuhlc. I,nu PmA.cm i
Division of Water Resources.I'nderground Injection Control Program.
FOR III,Al-Fit tit ['III If IiN t IF S ON[ N: 1636 Mail Senice Center,Raleigh,N('27699-1636
13a.1 ielit Igp lu \Iefhoit of test: 24e. For NN ale.Supple& Injection NN ells:
\hn .uhnm one cope IT TIT tOlm ouhlm ;u Jmsol c,m.p1<uon.,I
13b.Dtonfeclion 11 PC: AnlounC "'11 eonsuucuon to the count, lealth department of the count_v "here
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nm JAA-I Aonh, oLhu.,Uq,e un.nl nlmwmulaul.uldAducal tie>ouleas-U n..un IT f Al.ael R...num ft..ned Auv,Ll]cal: